This study is a cross sectional self-administered mailed survey designed to address the type and frequency of ethical dilemmas faced by physicians, how they approach them, the types of ethical support they would find useful in addressing these ethical dilemmas, and their attitudes and practices in situations of scarce resources. The questionnaire was designed, piloted, translated and back translated. Following IRB approval, the study sample included 656 general practitioners and general internists from each of four European countries including England, Switzerland, Norway and Italy. In the last year a sample of physicians from Sri Lanka has been surveyed to examine how ethical dilemmas related to bedside rationing from a developing country compare to those in developed, resource-rich countries that have already been surveyed. The results have been analyzed and six peer reviewed journal articles have been published and two book chapters have been published. These publications report: 1. The ethical difficulties encountered in clinical Practice by European doctors. 2. Physicians access to ethics support services in the four european countries in the study. 3. The prevalence and determinants of physician bedside rationing in four European countries. 4. Physicians views on resource availability and equity in four European health care systems. 5. An examination of whether ethics consultants should help clinicians face scarcity in their Practices. In the last year a sample of physicians from Sri Lanka has been added to the study and has been surveyed to examine how ethical dilemmas related to bedside rationing from a developing country compare to those in developed, resource-rich countries that have already been surveyed.The study has been amended to include 700 Sri Lankan physicians for comparison with the European sample. IRB approval has been attained at the NIH for the Sri Lankan survey. Response rates in Sri Lanka have been low and the study will consequently be modified, pending IRB review, to use focus groups rather than mailed surveys.